Behavioral health carve-outs limit access of women with breast cancer to psychotherapy and related medications
A tumult of emotions typically bombard women diagnosed with breast cancer, ranging from severe anxiety and depression to shock and disbelief. Although 22 to 40 percent of women with breast cancer suffer significant psychological distress, at most only 30 percent of them receive psychotherapy or medication. Women have less access to psychotherapy and psychotherapeutic medications if mental health services are provided by behavioral health carve-outs in their insurance program rather than as integrated services, concludes a new study.
Researchers at the Dana-Farber Cancer Institute and Harvard Medical School analyzed insurance claims, enrollment data, and insurance benefit design data from 1998 to 2002 from the MarketScan Commercial Claims & Encounters Research Database on women 63 years of age and younger with newly diagnosed breast cancer. They compared medication and psychotherapy use among women whose behavioral health services were provided through carve-outs (which are administered and managed separately from other health services) versus integrated arrangements, during the year after a breast cancer diagnosis.
Women enrolled in carve-outs were 32 percent less likely to receive any psychotherapy visits compared with a matched group of women in integrated arrangements. Conditional on having received psychotherapy, however, women in carve-out arrangements used more psychotherapy visits than women in integrated arrangements. The use of antianxiety/hypnotic drugs was also significantly higher for women in carve-out arrangements versus women in integrated arrangements (36.1 vs. 32.6 percent). Providers who refer women with breast cancer for behavioral health services should realize that some women face more complicated paths into treatment than others.
The study was supported by the Agency for Healthcare Research and Quality (HS10803). An editorial accompanies the paper. More details are in "Behavioral health services for women who have breast cancer," by Vanessa Azzone, Ph.D., Richard G. Frank, Ph.D., Juliana R. Pakes, M.Ed., and others, in the February 10, 2009, Journal of Clinical Oncology 27(5), pp. 706-712.
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